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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1032-E1038
DOI: 10.1055/a-1393-5469
Original article

Simple feedback of colonoscopy performance improved the number of adenomas per colonoscopy and serrated polyp detection rate

Osamu Toyoshima
1   Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
2   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Shuntaro Yoshida
1   Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
2   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Toshihiro Nishizawa
1   Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
3   Department of Gastroenterology and Hepatology, International University of Health and Welfare, Chiba, Japan
,
Tadahiro Yamakawa
1   Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
,
Toru Arano
1   Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
4   Department of Gastroenterology, The Fraternity Memorial Hospital, Tokyo, Japan
,
Yoshihiro Isomura
1   Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
5   Department of Gastroenterology, Kyoundo Hospital, Tokyo, Japan
,
Takamitsu Kanazawa
1   Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
6   Department of Gastrointestinal Surgery, JR Tokyo General Hospital, Tokyo, Japan
,
Hidehiko Ando
7   Gastroenterology, Ando Family Clinic, Tokyo, Japan
,
Yosuke Tsuji
2   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Kazuhiko Koike
2   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract

Background and study aims High-quality endoscopy requires improvement of not only the adenoma detection rate (ADR) but also the serrated polyp (SP) detection rate and the mean number of adenomas per positive procedure (MAP +). We evaluated whether a simple feedback of colonoscopy performance improves those quality indicators using propensity-score matching.

Patients and methods Eleven endoscopists were evaluated regarding colonoscopy performance including ADRs, SP detection rates, mean numbers of adenomas per procedure (MAPs), and MAPs + with their ranking in the clinic. Endoscopic performance was compared before and after the feedback.

Results Colonoscopies were performed for 874 patients before the feedback and 1,272 patients after the feedback. Using propensity-score matching, 803 patients before the feedback and 803 patients after the feedback were matched. ADR after the feedback was significantly higher than that before the feedback (50.8 % and 40.8 %, respectively). MAP after feedback was significantly larger than that before the feedback (0.92 and 0.69, respectively), as well as MAP + (1.96 and 1.69, respectively). Clinically significant SP detection rate was also improved from 10.0 % to 14.9 %.

Conclusions Feedback including ADR, MAP, MAP +, and clinically significant SR detection rate could improve on those quality indicators. Further studies are needed to effectively prevent colorectal cancer in colonoscopy practice.



Publication History

Received: 08 June 2020

Accepted: 26 October 2020

Article published online:
17 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Hoff G, Botteri E, Hoie O. et al. Polyp detection rates as quality indicator in clinical versus screening colonoscopy. Endosc Int Open 2019; 7: E195-E202
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Robertson DJ, Lieberman DA, Winawer SJ. et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 2014; 63: 949-956
    CrossrefPubMedGoogle Scholar
  • 3 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
    CrossrefPubMedGoogle Scholar
  • 4 Corley DA, Jensen CD, Marks AR. et al. Adenoma Detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
    CrossrefPubMedGoogle Scholar
  • 5 Brenner H, Chang-Claude J, Seiler CM. et al. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med 2011; 154: 22-30
    CrossrefPubMedGoogle Scholar
  • 6 Arain MA, Sawhney M, Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105: 1189-1195
    CrossrefPubMedGoogle Scholar
  • 7 Nalankilli K, Huynh XT, Lade S. et al. Increasing rates of SSA/P detection in a large open-access Australian colonoscopy cohort. Endosc Int Open 2019; 7: E310-E316
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 East JE, Atkin WS, Bateman AC. et al. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut 2017; 66: 1181-1196
    CrossrefPubMedGoogle Scholar
  • 9 Bettington M, Walker N, Rosty C. et al. Clinicopathological and molecular features of sessile serrated adenomas with dysplasia or carcinoma. Gut 2017; 66: 97-106
    CrossrefPubMedGoogle Scholar
  • 10 Coe SG, Crook JE, Diehl NN. et al. An endoscopic quality improvement program improves detection of colorectal adenomas. Am J Gastroenterol 2013; 108: 219-226
    CrossrefPubMedGoogle Scholar
  • 11 Gurudu SR, Boroff ES, Crowell MD. et al. Impact of feedback on adenoma detection rates: Outcomes of quality improvement program. J Gastroenterol Hepatol 2018; 33: 645-649
    CrossrefPubMedGoogle Scholar
  • 12 Neilson LJ, East JE, Rajasekhar PT. et al. Sustained colonoscopy quality improvement using a simple intervention bundle. Endoscopy 2020; 52: 285-292
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Mahadev S, Jin Z, Lebwohl B. et al. Trainee colonoscopy quality is influenced by the independent and unobserved performance characteristics of supervising physicians. Endosc Int Open 2019; 7: E74-E82
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Ussui V, Coe S, Rizk C. et al. Stability of increased adenoma detection at colonoscopy. Follow-up of an endoscopic quality improvement program-EQUIP-II. Am J Gastroenterol 2015; 110: 489-496
    CrossrefPubMedGoogle Scholar
  • 15 Li D, Woolfrey J, Jiang SF. et al. Diagnosis and predictors of sessile serrated adenoma after educational training in a large, community-based, integrated healthcare setting. Gastrointest Endosc 2018; 87: 755-765.e751
    CrossrefPubMedGoogle Scholar
  • 16 Bleijenberg AGC, van Leerdam ME, Bargeman M. et al. Substantial and sustained improvement of serrated polyp detection after a simple educational intervention: results from a prospective controlled trial. Gut 2020; 69: 2150-2158
    CrossrefPubMedGoogle Scholar
  • 17 Lam AY, Li Y, Gregory DL. et al. Association between improved adenoma detection rate and interval colorectal cancer rates after a quality improvement program. Gastrointest Endosc 2020; 92: 355-364
    CrossrefPubMedGoogle Scholar
  • 18 Fayad NF, Kahi CJ. Quality measures for colonoscopy: a critical evaluation. Clin Gastroenterol Hepatol 2014; 12: 1973-1980
    CrossrefPubMedGoogle Scholar
  • 19 Zhao S, Wang S, Pan P. et al. Magnitude, Risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 2019; 156: 1661-1674.e1611
    CrossrefPubMedGoogle Scholar
  • 20 Fedewa SA, Anderson JC, Robinson CM. et al. Prevalence of 'one and done' in adenoma detection rates: results from the New Hampshire Colonoscopy Registry. Endosc Int Open 2019; 7: E1344-E1354
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Toyoshima O, Yoshida S, Nishizawa T. et al. CF290 for pancolonic chromoendoscopy improved sessile serrated polyp detection and procedure time: a propensity score-matching study. Endosc Int Open 2019; 7: E987-E993
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Toyoshima O, Nishizawa T, Yoshida S. et al. Expert endoscopists with high adenoma detection rates frequently detect diminutive adenomas in proximal colon. Endosc Int Open 2020; 8: E775-E782
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Anderson JC, Butterly LF, Weiss JE. et al. Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2017; 85: 1188-1194
    CrossrefPubMedGoogle Scholar
  • 24 Klair JS, Ashat M, Johnson D. et al. Serrated polyp detection rate and advanced adenoma detection rate from a US multicenter cohort. Endoscopy 2020; 52: 61-67
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Rex DK, Ahnen DJ, Baron JA. et al. Serrated Lesions of the Colorectum: Review and Recommendations From an Expert Panel. Am J Gastroenterol 2012; 107: 1315-1330
    CrossrefPubMedGoogle Scholar
  • 26 Kashida H. Endoscopic diagnosis of sessile serrated polyp: A systematic review. Dig Endosc 2019; 31: 16-23
    CrossrefPubMedGoogle Scholar
  • 27 Nagtegaal I, Arends MJ, Odeze RD. et al. Tumours of the colon and rectum. In: The WHO Classification of Tumours Editorial Board (eds). WHO Classification of Tumours Digestive System Tumours. Lyon (France): International Agency for Research on Cancer (IARC); 2019
    Google Scholar
  • 28 Park SK, Kim HS, Yang HJ. et al. Coexistent adenoma and serrated polyps on index colonoscopy and the risk of metachronous advanced colorectal neoplasia. Endosc Int Open 2019; 7: E1748-E1754
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
    CrossrefPubMedGoogle Scholar
  • 30 Lee TJ, Rees CJ, Blanks RG. et al. Colonoscopic factors associated with adenoma detection in a national colorectal cancer screening program. Endoscopy 2014; 46: 203-211
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Nishizawa T, Suzuki H, Arita M. et al. Pethidine dose and female sex as risk factors for nausea after esophagogastroduodenoscopy. J Clin Biochem Nutri 2018; 63: 230-232
    CrossrefPubMedGoogle Scholar
  • 32 Nishizawa T, Sakitani K, Suzuki H. et al. Adverse events associated with bidirectional endoscopy with midazolam and pethidine. J Clin Biochem Nutr 2019; 66: 78-81
    CrossrefPubMedGoogle Scholar
  • 33 Toyoshima O, Hata K, Yoshida S. et al. New-generation chromoendoscopy may increase confidence in the DISCARD2 study. Gut 2018; 67: 1742-1743
    CrossrefPubMedGoogle Scholar
  • 34 Rajasekhar PT, Rees CJ, Bramble MG. et al. A multicenter pragmatic study of an evidence-based intervention to improve adenoma detection: the Quality Improvement in Colonoscopy (QIC) study. Endoscopy 2015; 10: 217-224
    PubMedGoogle Scholar
  • 35 Ell C, Fischbach W, Bronisch HJ. et al. Randomized trial of low-volume PEG solution versus standard PEG + electrolytes for bowel cleansing before colonoscopy. Am J Gastroenterol 2008; 103: 883-893
    CrossrefPubMedGoogle Scholar
  • 36 Bretthauer M, Aabakken L, Dekker E. et al. Requirements and standards facilitating quality improvement for reporting systems in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2016; 48: 291-294
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Zimmermann-Fraedrich K, Sehner S, Rex DK. et al. Right-sided location not associated with missed colorectal adenomas in an individual-level reanalysis of tandem colonoscopy studies. Gastroenterology 2019; 157: 660-671.e662
    CrossrefPubMedGoogle Scholar
  • 38 Gimeno García AZ, González Y, Quintero E. et al. Clinical validation of the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) II criteria in an open-access unit: a prospective study. Endoscopy 2012; 44: 32-37
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 van Doorn SC, Klanderman RB, Hazewinkel Y. et al. Adenoma detection rate varies greatly during colonoscopy training. Gastrointest Endosc 2015; 82: 122-129
    CrossrefPubMedGoogle Scholar
  • 40 Hilsden RJ, Rose SM, Dube C. et al. Defining and applying locally relevant benchmarks for the adenoma detection rate. Am J Gastroenterol 2019; 114: 1315-1321
    CrossrefPubMedGoogle Scholar